ABSTRACT
Introduction: The spectrum of clinical manifestations of COVID-19 in children is expanding since the global emergence of the COVID-19 pandemic from early reports in January 2020 depicting respiratory distress to a severe multisystem inflammatory syndrome (MIS-C) within various pediatric clusters. There is a paucity of data from resource-poor countries with respect to follow-up outcomes, particularly for coronary artery abnormalities. Considering this, we conducted a single centre prospective longitudinal study to describe the clinical, laboratory, echocardiographic findings and follow-up of children with MIS-C. Objectives: To study the clinical and laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to COVID-19. Methods: All children meeting the WHO case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4-6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the SPSS version 12 software. Results: 31 children with MIS-C were enrolled in an eleven-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding;gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight % of children presented with shock, and 22.5% required mechanical ventilation. The median (IQR) duration of hospital stay was 9 (6.5-18.5) days. Four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in nonsurvivors as compared to survivors [1061 (581,2750) vs 309.5 (140,720.08), p value=0.045] (table 1). Six children had coronary artery involvement: 5 recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome (table 1). Conclusion: Most children with MIS-C present with acute hemodynamic and respiratory symptoms. The outcome is favourable in children without preexisting comorbidities. Raised ferritin level may be a poor prognostic marker. The coronary outcomes on followup were reassuring.